Risk Factors and Risk Reduction of Malignant Seeding of the Percutaneous Endoscopic Gastrostomy Track from Pharyngoesophageal Malignancy: A Review of all 44 Known Reported Cases

Abstract

Strong risk factors for stomal metastases include: pharyngoesophageal primary cancer, squamous cell histology, less well-differentiated cancer, large size, and advanced cancer stage. The risk may be reduced in patients with risk factors by radiotherapy, chemotherapy, or cancer surgery before PEG; by substituting the push-guidewire for the pull-string technique for PEG; and possibly by use of a sheath with the pull-string technique.

Direct Puncture Endoscopic Assisted Gastrostomy: An Alternative Technique, Case Report

“…This Technique is widely standardized and used but has a disadvantage for head and neck and esophageal oncologic patients, since goes through the primary lesion as an obligated pathway for the tube placement. Therefore, carries tumoral cells trough the path of the tube and secondary metastasis could be present [8,[13][14][15][16][17]. With this purpose, we present the direct puncture endoscopic assisted Gastrostomy In this technique, the surgeon, with the endoscopic help, uses an inverse technique, avoiding the pass of the tube trough the head and neck tumor, reducing the risk of tumoral cell implant at the path and stoma.…”

“…33-69% of patients that need chemo-radiotherapy for upper aero digestive tract require PEG tube placement [11][12][13]. This group disserves particular attention since tumoral seeding in gastrostomy stomas have been reported [13][14][15][16][17], primary from the oropharynx, hypopharynx, oral cavity and larynx. Being the pull technique the most associated with metastases reports, reason why new methods for gastrostomy placement have been studied, especially for the ones that require pre-surgical feeding or for nutritional feeding after mayor head and neck surgical intervention [12,18,19].…”

Modificação de dispositivo para gastrostomia endoscópica percutânea pela técnica de punção: utilização em pacientes com neoplasia maligna de cabeça e pescoço

“…Muitos autores recomendam a realização de gastrostomias cirúrgica ou radiológica em pacientes com CCP ou utilização dos métodos da GEP por "punção" e até uso de "overtube" para evitar o contato do tumor com as sondas 53,150,151,152 .…”

“…Para esta situação, outra alternativa é a GEP pela técnica do "introdutor" ou de "punção" 16,42,[51][52][53][54] . Nesta modalidade, a introdução da sonda é realizada exclusivamente por via abdominal diretamente na câmara gástrica, utilizando-se a visão endoscópica apenas para controle do procedimento 51 .…”

“…Embora sua frequência seja inferior a 1%, tratase de complicação que compromete ainda mais a precária qualidade de vida dos doentes, podendo até reduzir a sobrevida 53,147,148,149 Cabe ressaltar que a presença de implante no local da punção, apesar de todas as teorias que explicam o evento, na literatura, foi observada unicamente nos pacientes que foram submetidos à GEP pela técnica de "tração", corroborando que a passagem da sonda através do tumor com consequente descamação das células neoplásicas e posterior implante no sitio de punção da GEP no abdome, seja a causa desse evento 53,147 .…”